A Typical Day

Non on call days tend to follow a similar structure across all resident doctor rotations. 

Days start with a handover with a nominated member of the ward teams usually attending, to gather information about new admissions as well as any handover around existing patients. This usually centres around overnight reviews for clinical deterioration, falls etc. 

Handover is a vital part of patient care and allows for patient details, medical background, current issues and management plans to be discussed. It also allows for transfer of responsiiblity of any outstanding jobs to the appropriate people. 

Then comes the ward round. Ward rounds vary significantly in length and tend to depend on how many patients are under your teams care. You'll be responsible for prepping ward round notes, documenting during the round and collating jobs. 

TOP TIP: 

Carry a separate sheet to collate jobs on the go. It's always a pain to have to hunt down the notes again afterwards, and this minimises the risk of jobs being missed. 

Post ward round you'll find yourself with a number of post round jobs as well as new jobs being added throughout the day. These will range from prescribing, ordering or reviewing investigations, writing discharge summaries through to communication with the wider MDT, patients or their relatives. 

Preparing for Ward Rounds 

Before the round: 

You'll generally have some time in the morning to update the list before the senior members of the team arrive to start the round. 

Remember to add any new admissions, update any overnight bloods or scan results for patients who have been reviewed overnight and make sure any outstanding jobs from previous days are pre-populated. 

During the round: 

This is the point where  computer based notes systems are excellent as  you have a laptop with you. You're going to be responsible for documenting and we'll come to a structure for this later on, as well as prescribing additional medications, ordering investigations and keeping the jobs list updated - think family updates, referral letters, arranging outpatient follow up... 

You might also feel like you need 3 sets of arms to juggle the notes, observation folders, drugs charts if you're working somewhere where paper is the mainstay of documentation. Just take it one patient at a time and you'll soon find your pace. 

After the round: 

It's time to collate the jobs and start prioritsing them by urgency and importance. More on that later. What I would suggest is batching them together by ward or type of job where possible. 

It's a lot easier to order investigations in one go whilst logged into the computer rather than go ward to ward, unless there are additonal details you need to book the investigation. 

Priotisiting Jobs 

Priorisiting jobs can feel like an incredibly difficult task at times. A way I've found particulary useful is to split it into 

• Important and urgent - these jobs come first eg NEWS 7 

• Important but not urgent - Regularly work on but can be left for a period of time if necessary eg discharge summary prepping 

• Not important but urgent - Deal with efficiently or delegate eg cannula resite for antibiotics in 1 hours - see if a member of the MDT can help. 

• Not important and not urgent - The hardest to group things into but think non urgent paper work eg  fit to fly letters. 

Expectations 

Being an F1 is a big step up from being a medical student. It can feel like a lot at times but remember you're part of a team and you should have lots of support around you. 

Expectations include: 

• Assessing patients and escalating appropriately 

• Reviewing investigations and actioning results 

• Prescribing medications and fluids 

• Completing discharge summaries / referral letters 

• Attending ward round 

• Communicating with the MDT, patients and their relatives 

• Performing practical procedures where competent 

That said, you aren't expected to know everything. You aren't expected to manage sick patients alone or to make decisions beyond your competence. All of this stuff comes with time.  

TOP TIP: 

It's always ok to ask for help. Your seniors expect it and are there to help. 

Clinical Documentation 

My first week as a surgical F1 I remember the SHO's top tip. 'If you didn't document it, then it never happened.' That advice has stuck with me and remains true. Documentation is essential. It doesn't just record what you've done, it allows the other members of the team to see, or the night team to get a clear picture of what's previously happened. 

So keep it clear, legible and concise. 

Good documentation includes: (1) 

• Name of those reviewing and their role - eg J Bloggs, FY1 General Surgery 

• Reason for review - Ward round, High NEWS... 

• Structured history and review - SOAP can be useful here (1) 

  • Subjective - what the patient says 

  • Objective - the observations and examination findings 

  • Assessement - What your impression is 

  • Plan - What actions are going to be taken 

• ABCDE is also a useful documentation structure for clinical assessment.  

• And don't forget to sign it with your name, role and GMC number - A stamp is pretty useful for this.

Communication skills 

A sometimes undervalued skill but actually key to developing good working relationships with colleagues, patients and relatives alike. We'll cover this in detail in the communication session. 

General strategies

Firstly there are many many many different approaches. They key thing is to find what works for you. These are just some tips that you may find helpful 

• Keep your list organised and update it as you go 

• Prioritise - for example using a traffic light system of RED for immediate jobs, AMBER for urgent but not immediate and GREEN for needs to be done but can wait. 

• Keep a jobs list, keep track of what's been done 

• Batch jobs together. Easier than wandering back and forth eg book scans in one go 

• Work with the MDT 

• Communicate clearly if there are delays 

• Escalate eary 

• Keep on top of documentation 

• Try and stay organised - ie prep discharges and TTOs in advance. 

  • Useful to spend sometime making templates for something like post op elective hips as there will be quite a lot of overlap between discharge plans

Remember this is just a guide and you'll find things that work for you. This generally works well in my practice but everyone is different. Take it a day at a time and make sure you stop to hydrate and to eat! 

Disclaimer:

This is a not for profit education resource designed for new resident doctors. All information serves as a guide to help doctors approach day to day life as an F1. It is not intended as a guide to patient care and should never be used as such or in place of advice of treating clinicians or published clinical guidelines. All cases are fictional and any resemblance is purely coincidental. Additionally all images are AI generated unless otherwise stated. 

References: 

1. Geeky Medics - How to document a patient assessment. (2017). - https://geekymedics.com/document-patient-assessment-soap/

2. 
   

Disclaimers